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Karen was sexually abused by her father at the age of 5. She developed a severe separation anxiety reaction whenever her mother tried to leave. As an adult, karen developed a dissociative disorder. This is an example of how the same factor, in this case abuse, can be

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I believe the answer is: both a proximal and a distal causal factor.

Proximal causal factors refers to the causal factors that start to exist not long before the symptoms of the disorder start to appear. Distal causal factors refers to the causal factors that strat early in the patient's life but stay hidden until years after the initial symtoms.

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